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Global syphilis prevalence declines over 3 decades
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A new database of syphilis prevalence in the adult general population showed an overall decrease in every WHO region since 1990, according to researchers.
“The downward trends in prevalence in all regions were remarkable,” Alex Smolak, PhD, consultant for the Infectious Disease Epidemiology Group at Weill Cornell Medicine, Cornell University, and colleagues wrote in Clinical Infectious Diseases. “Though there were differences in the decline rates, the decline was consistent in all regions, suggesting a global phenomenon.”
Smolak and colleagues compiled the database using information that was gathered for the 2015 Global Burden of Disease Study as well as WHO data, national surveillance reports and data from the Global AIDS monitoring system. The analysis included 1,103 syphilis prevalence measures representing 136 million syphilis tests (85% of which from women receiving antenatal care) across 154 countries.
The median prevalence of syphilis was 1.11% (95% CI, 0.99-1.22) worldwide, according to the data. Regional prevalence was lowest in Europe at 0.12% and highest in Africa at 3.04%. Compared with Africa, the adjusted OR for syphilis prevalence was 0.05 (95% CI, 0.03-0.07) in Europe, 0.13 (95% CI, 0.09-0.19) in the Eastern Mediterranean, 0.21 (95% CI, 0.16-0.28) in Southeast Asia, 0.41 (95% CI, 0.32-0.53) in the Western Pacific, and 0.42 (95% CI, 0.33-0.54) in the Americas.
Further analyses revealed that prevalence declined several percentage points over time across all regions. The aOR per year was 0.97 (95% CI, 0.93-1.01) for the Western Pacific, 0.95 (95% CI, 0.93-0.97) for Africa, 0.94 (95% CI, 0.87-1.03) for Europe, 0.92 (95% CI, 0.88-0.97) for the Americas, 0.90 (95% CI, 0.86-0.94) for Southeast Asia and 0.84 (95% CI, 0.79-0.90) for the Eastern Mediterranean. Sensitivity analyses yielded similar results.
“Despite overall regional declines, few individual countries, such as the United States, have been experiencing increases over the last few years,” Smolak told Infectious Disease News. “The increases we see in several countries globally appear to be affected by epidemics occurring among men who have sex with men (MSM), with some spillover to other populations.”
According to the CDC, the number of primary and secondary syphilis infections in the U.S. has increased almost every year since 2001, from 2.1 cases per 100,000 population to 8.7 cases per 100,000 in 2016. There was a nearly 18% increase in cases between 2015 and 2016 alone. Men accounted for 90% of all cases in 2016. Among those with available data, 80.6% were MSM.
“This highlights the need for continued vigilance in syphilis testing and treatment,” Smolak said. – by Stephanie Viguers
References:
CDC. National Overview of STDs, 2016. https://www.cdc.gov/std/stats16/natoverview.htm. Accessed November 17, 2017.
Smolak A, et al. Clin Infect Dis. 2017;doi:10.1093/cid/cix975.
Disclosures: The authors report no relevant financial disclosures.